Licence Appeal Tribunal File Number: 24-012675/AABS
In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.
Between:
Monique C. Antier
Applicant
and
Allstate Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
Melanie Malach
APPEARANCES:
For the Applicant:
Daniel Lester, Counsel
For the Respondent:
Parthenia Magharious, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Monique Antier, the applicant, was involved in an automobile accident on August 2, 2023, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Allstate Insurance Company of Canada, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
i. Is the applicant entitled to $2,857.77 for medical cannabis, proposed by Apollo Applied Research Inc., in a treatment plan dated September 27, 2024?
ii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3I find that the applicant is entitled to $2,857.77 for medical cannabis, proposed in the treatment plan dated September 27, 2024, plus interest.
4I find that the respondent is not liable to pay an award under s. 10 of Reg. 664.
ANALYSIS
Entitlement to the Treatment Plan for Medical Cannabis
5The applicant claims entitlement to $2,857.77 for medical cannabis, proposed by Dr. Dave Chaudhary, of Apollo Applied Research Inc, in a treatment plan dated September 27, 2024.
6To receive payment for a treatment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify that the goals of treatment are reasonable, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
7The applicant submits that she suffered significant injuries and impairments in the subject accident. According to the Consultation Note of Dr. Eric Davenport, dated August 8, 2023, she suffered a right ulnar shaft fracture, as well as complex pelvic acetabular fractures. She also suffered from a subdural hematoma, subgaleal hematoma, a right sided maxillary bone fracture, a C5-C6 right-sided posterior element fractur, with possible epidural hematoma, liver lacerations, as well as a fracture to the transverse process of L5. She underwent an Orthopaedic Surgery assessment with Dr. Pardeep Alexander, on May 9, 2024, which documents her ongoing complaints and functional limitations. The report notes her history of substance and narcotic abuse and states that it is therefore difficult to treat the applicant with pain medications and manage her pain.
8The applicant submits that she consulted Dr. Dave Chaudhary at Apollo Applied Research Inc. regarding her pain management, and the subject treatment plan was prepared dated September 27, 2024, recommending medical cannabis therapy. She notes that she has been attempting abstinence from illicit drugs since June 2024 and she does not wish to rely on opioid based pain medications given her history of substance abuse. The applicant submits that Dr. Chaudhary provides several additional comments appended to the treatment plan with rationales for the medical cannabis products recommended. He notes that the cannabis therapy is expected to effectively manage her pain symptoms, thereby enhancing her functionality. Effective symptom management is anticipated to lead to substantial improvements in both the quality and quantity of her sleep which will positively impact her quality of life, mood, and motivation. He then goes on to state that she has been prescribed medical cannabis to ensure proper management of her accident-related medical symptoms.
9By letter dated October 10, 2024, the respondent denied the treatment plan for the following reasons:
It is unclear if the prescribed choice of Medical Cannabis could make you more vulnerable to experiencing less desirable effects, including cognitive impairment, anxiety, paranoia, and dependence, given the reported history of substance abuse (crack cocaine).
The potential benefits of medical cannabis for chronic pain are unproven.
10In an Explanation of Benefits (“EOB”), dated January 9, 2025, the respondent denied the treatment plan based on the Physiatry Insurer’s Examination (“IE”) report of Dr. Aleksandra Zietak, physiatrist, dated December 31, 2024.
11The applicant submits that Dr. Chaudhary provided a rebuttal report dated February 19, 2025, in response to the respondent’s reasons for denying the subject treatment plan and the opinions expressed by the IE assessor in her report. Dr. Chaudhary points out the most problematic issues with the study relied upon by Dr. Zietak and then provides several medical studies that support the effectiveness of medical cannabis as a pain reliever for chronic pain. He then goes on to explain that there is a significant difference between medical versus recreational cannabis. Finally, he addresses the respondent’s alleged concern and reason for denial, being that medical cannabis may result in cognitive impairment, anxiety, paranoia and dependence. Dr. Chaudhary concludes by re-iterating that the use of medical cannabis with medical oversight and management is medically indicated in this case.
12The respondent submits that the applicant has failed to provide evidence to support a finding that the subject treatment plan is reasonable and necessary. It relies upon the IE report of Dr. Zietak, which concluded that currently the applicant requires no prescription or nonprescription medication as a direct result of her injuries sustained in the subject accident. She further opined that the treatment plan in dispute is not reasonable and necessary due to the applicant’s history of substance abuse, notably crack cocaine. She noted research from the American Journal of Addictions of August 7, 2023, which concluded that daily cannabis use may make chronic pain worse over time by reducing pain tolerance. In addition, daily cannabis users risk addiction without any long-term benefit for chronic pain.
13The respondent further relies upon a second IE report by Dr. Zietak, dated April 28, 2025, which opined that following review of additional documentation provided, her opinion remains unchanged. Dr. Zietak concluded that given the diagnosis of Substance Abuse Disorder, it is not reasonable for the applicant to be prescribed cannabis.
14I find that the applicant is entitled to the treatment plan for medical cannabis.
15There is no dispute that the applicant suffers with a history of substance abuse. I find that the treatment plan in dispute specifically addresses her history of substance abuse and recommends a program where the applicant’s use of cannabis will be medically managed. I find the applicant acknowledges that she cannot be prescribed opioids for her pain management and therefore requires an alternative form of treatment in order to address her medical issues and provide her with relief to improve her functionality. This is not a situation where the applicant is asking for cannabis without any proper monitoring or control by a third party with respect to her dosage and intake. The treatment plan specifically provides for medical management and instructions/support activity.
16I find upon review of the report of Dr. Zietak, that the applicant’s ongoing complaints and functional difficulties are set out in detail. It notes that she requires a follow-up with her surgeon regarding her pelvic fractures and the fractured sacroiliac screw and her right forearm fracture to determine if further treatment is required. Dr. Zietak concluded that the applicant currently requires no prescription or nonprescription medication as a direct result of the injuries sustained in the subject accident. Dr. Zietak refers to the American Journal of Addictions research article dated August 7, 2023, which concludes that daily cannabis use may make chronic pain worse over time by reducing pain tolerance and users risk addiction without any long-term benefit for chronic pain. I agree with the comments made by Dr. Chaudhary in his rebuttal report that this study referenced by Dr. Zietak does not specify the type of cannabis being used, nor does it distinguish between medical cannabis and recreational cannabis. I accept Dr. Chaudhary’s opinion that the specific type of cannabis used, the dosing regimen, or the mode of consumption, can significantly impact the pain-relief properties of cannabis and medical cannabis is has therapeutic benefits for individuals like the applicant.
17I give weight to the rebuttal report by Dr. Chaudhary, where he relies on various studies where there is clear evidence that cannabinoids can reduce pain intensity, pain interference and improve quality of life in patients with chronic pain. Dr. Chaudhary notes that the study relied upon by Dr. Zietak does not specifically address cases of chronic pain resulting from traumatic injuries, such as those sustained by the applicant. He argues that the pain mechanisms in her case are related to severe, physical trauma, rather than the generalized pain profiles seen in other chronic pain patients. I accept Dr. Chaudhary’s opinion that the studies he relies upon support the efficacy of medical cannabis in reducing chronic pain and improving quality of life. I further accept that Dr. Chaudhary has provided sufficient evidence to support the importance of using a carefully controlled, physician-monitored approach to cannabis use, which the applicant requires and the treatment plan in dispute recommends.
18I therefore give more weight to the report of Dr. Chaudhary where he has addressed all of the concerns raised by Dr. Zietak in her report based on studies completed on the benefits of medical cannabis in chronic pain cases. I further find that he has linked the findings in these studies to the applicant’s specific injuries and history. I find that this report supports the use of medical marijuana based on the applicant’s history of substance abuse, the pain complaints currently being made and the positive effects of treatment on her functionality and improvement.
19For the reasons outlined above, I find that the applicant has proven on a balance of probabilities, that the treatment plan for medical cannabis is reasonable and necessary as a result of the injuries sustained in the accident.
Interest
20Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As I have found that the applicant is entitled to the treatment plan in dispute, interest is payable pursuant to s. 51 of the Schedule.
Award
21The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 percent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
22The applicant submits that an award is payable because the respondent was provided with hospital records, medical records and treatment records since the outset of the applicant’s accident benefit claim. They are aware that the applicant suffered a polytrauma and that she has substance abuse issues. They are also aware that the applicant is doing everything in her power to remain sober. The applicant further submits that the respondent denied the treatment plan within a day of its submission without any discussion with Dr. Chaudhary and it does not care to understand the medical support for the treatment plan. The applicant argues that the respondent does not care that she is suffering pain and had not alternative relief available to her.
23The respondent submits that it has outlined reasons for the denial of the treatment plan in dispute and denies that it has unreasonably withheld or delayed payment of any accident-benefits. It submits that the applicant has not demonstrated that the respondent’s conduct meets the high threshold of being “immoderate, imprudent, inflexible and excessive”.
24I find that while I have found that the treatment plan in dispute is reasonable and necessary, the applicant has not proven that the respondent’s conduct was “immoderate, imprudent, inflexible and excessive” to meet the threshold for an award. I find that the respondent was entitled to rely on the reports of its IE assessors in denying the treatment plan in dispute despite my finding that it was reasonable and necessary based on the evidence provided.
25For the reasons outlined above, I find that the applicant has not proven on a balance of probabilities that she is entitled to an award.
ORDER
26For the reasons outlined above, I find:
i. The applicant is entitled to $2,857.77 for medical cannabis, proposed in the treatment plan dated September 27, 2024, plus interest;
ii. The respondent is not liable to pay an award under s. 10 of Reg. 664.
Released: March 16, 2026
Melanie Malach
Adjudicator